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Pneumatosis cystoides interstitialis: A complication of graft-versus-host disease. A report of two cases.

Laskowska K, Burzyńska-Makuch M, Krenska A, Kołtan S, Chrupek M, Nawrocka E, Lasek W, Serafin Z - Pol J Radiol (2012)

Bottom Line: PCI was diagnosed based on a CT exam and was confirmed by a colonoscopy.CT is a method of choice to diagnose PCI.In patients with PCI, the presence of free air in the peritoneal cavity does not confirm an intestinal perforation.

View Article: PubMed Central - PubMed

Affiliation: Chair and Department of Radiology and Diagnostic Imaging, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland.

ABSTRACT

Background: Pneumatosis cystoides intestinalis (PCI) is a rare disorder characterized by the presence of multiple gas collections in the subserosal or submucosal intestinal wall of the large or small intestine. We report two cases of PCI in the course of chronic graft-versus-host disease.

Case report: A 5-year-old girl was treated for acute lymphoblastic leukemia. Twenty-four months after the hematopoietic stem cell transplantation, in the course of graft-versus-host disease, she developed subcutaneous emphysema of the right inguinal and pudendal region. PCI was diagnosed based on a CT examination. A 3-year-old boy was treated for juvenile myelomonocytic leukemia. Fourteen months after the hematopoietic stem cell transplantation he presented with an increased severity of intestinal symptoms, including intermittent bleeding from large intestine. PCI was diagnosed based on a CT exam and was confirmed by a colonoscopy.

Conclusions: Pneumatosis cystoides interstitialis in the course of chronic graft-versus-host disease has a heterogeneous clinical presentation that does not correlate with results of imaging. CT is a method of choice to diagnose PCI. In patients with PCI, the presence of free air in the peritoneal cavity does not confirm an intestinal perforation.

No MeSH data available.


Related in: MedlinePlus

Patient 2. Endoscopic Picture of PCI with a submucosal air collection (arrow).
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f3-poljradiol-77-2-60: Patient 2. Endoscopic Picture of PCI with a submucosal air collection (arrow).

Mentions: After 14 months from transplantation, the child’s clinical state significantly deteriorated: intestinal symptoms exacerbated and there were episodes of gastrointestinal bleeding. Abdominal CT examination showed air in the intestinal wall and single extraintestinal air collections present within fat tissue and mesentery (Figure 2). Individual intestinal loops were dilated to 3 cm with contrast-enhanced walls. Presence of air in the large bowel wall was confirmed with endoscopy (Figure 3). Conservative combination treatment was applied and the entire time of therapy was complicated by episodes of massive lower gastrointestinal bleeding. In a control abdominal CT scan performed 3 weeks later there was no air in the intestinal walls or outside the bowel, but contrast enhancement persisted in the walls of some intestinal loops. Endoscopy did not show any previously visible air collections either.


Pneumatosis cystoides interstitialis: A complication of graft-versus-host disease. A report of two cases.

Laskowska K, Burzyńska-Makuch M, Krenska A, Kołtan S, Chrupek M, Nawrocka E, Lasek W, Serafin Z - Pol J Radiol (2012)

Patient 2. Endoscopic Picture of PCI with a submucosal air collection (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3403803&req=5

f3-poljradiol-77-2-60: Patient 2. Endoscopic Picture of PCI with a submucosal air collection (arrow).
Mentions: After 14 months from transplantation, the child’s clinical state significantly deteriorated: intestinal symptoms exacerbated and there were episodes of gastrointestinal bleeding. Abdominal CT examination showed air in the intestinal wall and single extraintestinal air collections present within fat tissue and mesentery (Figure 2). Individual intestinal loops were dilated to 3 cm with contrast-enhanced walls. Presence of air in the large bowel wall was confirmed with endoscopy (Figure 3). Conservative combination treatment was applied and the entire time of therapy was complicated by episodes of massive lower gastrointestinal bleeding. In a control abdominal CT scan performed 3 weeks later there was no air in the intestinal walls or outside the bowel, but contrast enhancement persisted in the walls of some intestinal loops. Endoscopy did not show any previously visible air collections either.

Bottom Line: PCI was diagnosed based on a CT exam and was confirmed by a colonoscopy.CT is a method of choice to diagnose PCI.In patients with PCI, the presence of free air in the peritoneal cavity does not confirm an intestinal perforation.

View Article: PubMed Central - PubMed

Affiliation: Chair and Department of Radiology and Diagnostic Imaging, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland.

ABSTRACT

Background: Pneumatosis cystoides intestinalis (PCI) is a rare disorder characterized by the presence of multiple gas collections in the subserosal or submucosal intestinal wall of the large or small intestine. We report two cases of PCI in the course of chronic graft-versus-host disease.

Case report: A 5-year-old girl was treated for acute lymphoblastic leukemia. Twenty-four months after the hematopoietic stem cell transplantation, in the course of graft-versus-host disease, she developed subcutaneous emphysema of the right inguinal and pudendal region. PCI was diagnosed based on a CT examination. A 3-year-old boy was treated for juvenile myelomonocytic leukemia. Fourteen months after the hematopoietic stem cell transplantation he presented with an increased severity of intestinal symptoms, including intermittent bleeding from large intestine. PCI was diagnosed based on a CT exam and was confirmed by a colonoscopy.

Conclusions: Pneumatosis cystoides interstitialis in the course of chronic graft-versus-host disease has a heterogeneous clinical presentation that does not correlate with results of imaging. CT is a method of choice to diagnose PCI. In patients with PCI, the presence of free air in the peritoneal cavity does not confirm an intestinal perforation.

No MeSH data available.


Related in: MedlinePlus